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Intellectual function and age of repair in cyanotic congenital heart disease
R K Oates1, J M Simpson, T B Cartmill
1University of Sydney, Camperdown, NSW, Australia.
Insights
Delaying surgery for congenital heart defects like tetralogy of Fallot and transposition of the great arteries (TGA) does not negatively impact intellectual development in children. Neuropsychological assessments confirm no detrimental effects from older operating ages.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Congenital Heart Disease
Background:
- Congenital heart disease (CHD) significantly impacts child development.
- Tetralogy of Fallot and Transposition of the Great Arteries (TGA) are common cyanotic CHDs requiring surgical intervention.
- The optimal timing for surgical correction and its long-term neurodevelopmental outcomes remain areas of investigation.
Purpose of the Study:
- To evaluate the neurodevelopmental outcomes in children with Tetralogy of Fallot and TGA.
- To determine if older age at surgical operation correlates with adverse intellectual development in these pediatric populations.
- To assess the impact of delayed surgery on cognitive function in children with cyanotic heart disease.
Main Methods:
- Utilized the Wechsler Intelligence Scale for Children--Revised (WISC-R) and a battery of neuropsychological tests.
- Assessed 81 children (51 with Tetralogy of Fallot, 30 with TGA) and compared them to 33 children who underwent surgery for Ventricular Septal Defect.
- All participants were over 10 years old, in good health, and attending normal schools at the time of review.
Main Results:
- No significant negative correlation was observed between IQ scores (overall or subtests) and the age at which surgery was performed.
- Neuropsychological measures did not indicate any detrimental effects associated with older operating ages in children with cyanotic heart disease.
- Intellectual development in children with TGA or Tetralogy of Fallot showed no adverse impact from delayed surgical intervention.
Conclusions:
- Delayed surgical correction for Tetralogy of Fallot and TGA does not appear to negatively affect intellectual development.
- These findings offer reassurance for managing cases where surgical intervention must be postponed due to medical, social, or economic factors.
- Neurodevelopmental outcomes are not compromised by waiting for surgery in children with these specific congenital heart conditions.
Abstract:
Eighty one children, comprising 51 with tetralogy of Fallot and 30 children with transposition of the great arteries (TGA) were assessed using the Wechsler intelligence scale for children--revised, and a battery of neuropsychological measures. They were compared with a group of 33 children who had surgery for ventricular septal defect. All children were aged over 10 years when reviewed and were in good health, attending normal schools. No significant negative correlation was found between any component or subtest of the IQ scores and operating age. There was no evidence of a detrimental effect of older age at operation in the children who had cyanotic heart disease as assessed by neuropsychological measures. Delaying surgery for children with TGA or tetralogy of Fallot does not appear to adversely affect their intellectual development. This finding may provide reassurance in cases where surgery has to be delayed for medical, social, or economic reasons.